Provider Demographics
NPI:1902957350
Name:SMIDA, MARYAGNES (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:MARYAGNES
Middle Name:
Last Name:SMIDA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MRS
Other - First Name:AGGIE
Other - Middle Name:
Other - Last Name:SMIDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:75 E MAIDEN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4963
Mailing Address - Country:US
Mailing Address - Phone:724-554-2191
Mailing Address - Fax:724-229-3277
Practice Address - Street 1:75 E MAIDEN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4963
Practice Address - Country:US
Practice Address - Phone:724-554-2191
Practice Address - Fax:724-229-3277
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA524957OtherPROVIDER VALUEOPTIONS,VBH
PAPC001554OtherLICENSE-LPC
GA61973OtherNATIONAL CERTIFICATION